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What is Blepharitis?
Blepharitis is a common ophthalmological problem that is characterized by the inflammation of the eyelids.
The eyelashes grow out of hair follicles that have small oil glands underneath them, known as meibomian glands. Blepharitis occurs when these subcutaneous glands lining the eyelids become clogged or irritated, usually due to a bacterial infection or a skin condition.
Causes of Blepharitis
Several factors can lead to eyelid inflammation.
Malfunctioning Meibomian Glands: The meibomian glands present under the roots of the eyelashes produce an oily substance called meibum.
It forms an impervious layer over the eye’s tear film. This oily secretion locks down the moisture in your eyes by preventing the tears from evaporating.
Blepharitis occurs when the meibomian glands become clogged or inflamed and fail to produce enough oil to keep the eyes sufficiently lubricated.
An accumulation of debris, dust, dandruff, and skin flakes on the eyelids can lead to this kind of meibomian gland dysfunction.
Bacterial Overgrowth: The skin of the face and eyelids is naturally populated by harmless strains of bacteria. Your skin collects grime, dust, dead cells, and other impurities daily. Hence, proper skin hygiene routine is warranted.
Unclean skin provides a favorable environment for the bacteria to proliferate rapidly and accumulate along the margins of the eyelids. This bacterial buildup can irritate the delicate skin over the eyelids and pave the way for infection.
The infected eyelid tends to become red, itchy, swollen, and scaly – a condition called blepharitis.
Mite Infestation: The excessive growth of bacteria in the folds and crevices of the eyelids leads to the formation of a plaque-like biofilm. This biofilm serves as fodder for the eyelash mite Demodex.
These parasites gravitate toward the contaminated skin and derive their sustenance from the plaque. They multiply rapidly to give rise to a full-fledged mite infestation.
Medication: Certain medications can give rise to eyelid inflammation as a side effect. (3)
Allergies: Rarely, an allergic reaction to products used on your eyelids, which include eye makeup, eye medication, and contact lens liquid, can lead to eyelid inflammation.
Other Skin Conditions: Blepharitis is more prevalent in people with preexisting skin conditions such as seborrheic dermatitis (dandruff of the scalp and eyebrows), ocular rosacea, eczema, and psoriasis.
Anyone can develop blepharitis, regardless of their age, gender, or ethnicity. However, the condition seems to be more common in older adults who are above the age of 50 years.
The is no data to reveal the total number of blepharitis cases reported in the United States at a given time. Still, it is considered to be one of the most commonly reported complaints at both the ophthalmologist’s and optometrist’s offices. (4)
Signs and Symptoms of Blepharitis
In most cases of blepharitis, the symptomatic discomfort is equally pronounced in both the eyes, but some people may experience greater discomfort in one eye than in the other. The symptoms may come and go but are usually worst in the morning.
The following signs and symptoms characterize a typical case of blepharitis:
- Sore, swollen eyelids
- Itchiness in the eyelids or eyes
- Gritty sensation in the affected eye, which makes you feel like you have a foreign particle stuck in it
- Peeling, flaky, or crusty skin around the base of the eyelashes
- Redness in the eyes or over the eyelids
- Increased sensitivity to light (photophobia), which may trigger a mild headache or nausea
- Greasy green-colored fluid discharge from the eyes, which causes your eyelids to stick together in the morning when you wake up
- Increased blinking
- Burning or stinging of the eyes
Severe blepharitis can lead to the following signs and symptoms:
- Dry eyes
- Blurry vision
- Falling off of eyelashes, known as madarosis
- Misdirected growth of eyelashes at an abnormal angle on the eyelids
- Small ulcers or cysts (chalazion) and styes on the eyelids (5)
- Discomfort using contact lens due to lack of natural eye lubrication
- Puffiness around the eyes
- Watery eyes
- Eyelid scarring
Prolonged or poorly handled blepharitis can even give rise to secondary infection, especially in people who constantly rub or touch the affected area without sanitizing their hands before and after.
Diagnosis of Blepharitis
Your eye doctor will first review your symptoms and medical history to steer his diagnosis in the right direction. This preliminary inquiry will help the doctor rule out any associated medical condition that may be responsible for or contributing to the eyelid inflammation.
The doctor will then conduct a close examination of your eyes and eyelids through a special magnifying instrument called the slit lamp.
During the exam, the doctor will look for abnormalities in the lid structure, skin texture, eyelash growth, and opening of the meibomian gland.
Through this careful analysis, your doctor will be able to determine the type of blepharitis that you are suffering from and whether another skin condition, such as seborrheic dermatitis or rosacea, is making it worse.
If the doctor still has doubts about the diagnosis, he/she order a swab test of the oil or crust that forms on your eyelid to determine the presence of bacteria, fungi, or evidence of an allergy.
Your doctor may suggest the following treatments to manage blepharitis.
If the blepharitis is particularly severe and caused by unchecked growth of bacteria, your doctor may prescribe topical antibiotics to fight the underlying infection.
The topical options for blepharitis treatment include antibiotic creams, ointments, and eye drops.
A lot of eye doctors recommend ointments such as erythromycin and bacitracin ointments to curb the bacterial overgrowth on the eyelids. They may also prescribe a short course of cortisone medications for quick symptomatic relief.
It is essential that you follow your doctor’s instructions and use the stipulated dosage of the medicine to achieve the desired results without any side effects. Overuse of steroids, in particular, can seriously jeopardize your health in the long run.
If the topical treatment is insufficient in relieving your discomfort, your doctor may write you a prescription for oral antibiotics. The medication will be tapered off gradually after you overcome the acute phase, which usually lasts for several weeks.
Electromechanical lid margin debridement, also known as BlephEx, is a clinical procedure that involves scraping off the debris, bacteria, Demodex mites, and biofilm that form in the margins of the eyelids.
This is a widely used technique for opening up clogged meibomian glands to resume a healthy production of oils.
Thermal pulsation treatment is a clinical method that works by melting the debris that accumulated over the upper and lower eyelids. This is done through a localized application of heat and adaptive pressure in a controlled setting.
Intense pulsed light therapy uses a high-output flashlamp that emits nonlaser high-intensity light with a broad wavelength to melt, soften, and expel the accumulated matter blocking the eyelid glands. As a result, the normal flow of oils into the tear film is restored.
All things considered, these standard treatments and medications must be accompanied by a daily cleansing routine to achieve lasting relief.
Lifestyle and Home Remedies
Most cases of blepharitis do not require extensive medical treatment, and simple self-care measures usually suffice to provide considerable relief. The following home therapies can be used as first-line treatment for a regular case of blepharitis.
1. Follow a Daily Eyelid Hygiene Routine
The first and most important step toward treating blepharitis is to keep your eyelids free of dirt, germs, dead skin debris, and any toxin that can clog the meibomian glands or cause irritation.
Do following two to four times a day during a blepharitis flare-up and once or twice a day after the inflammation subsides:
- Use gentle heat therapy to soften the crusty deposits on your eyelids. Close your eye and place a warm compress over it for several minutes.
The application of heat will loosen or dislodge the greasy gunk and skin flakes. Simply wipe them off with a clean, damp washcloth after.
- Moisten a clean and soft washcloth with warm water.
- Put a few drops of diluted mild baby shampoo on it.
- Gently pull your eyelid away from the cornea and use the disinfecting washcloth to gently clean the debris stuck in your lash line.
- Swab away any residue on the eyelids or around the eye.
- After one eye is done, use a different clean cloth to sponge the other eye in the same manner.
- Splash some water on your eyelids for a final rinse, and then pat them dry with a clean, dry towel.
- If your doctor deems it fit, you can finish off by applying a topical antibiotic ointment to your eyelids.
2. Use Antidandruff and Antibacterial Shampoos
Blepharitis is often triggered or aggravated by other dermatological conditions such as seborrheic dermatitis, which refers to dandruff of the scalp and eyebrows.
In such cases, it is essential to manage the underlying condition for your eye inflammation to resolve.
People with dandruff should consider using shampoos and other hair care products that are specifically designed to address this problem.
Although there are several dandruff-controlling shampoos on the market, you should seek your doctor’s advice about which one is best suited for you.
If the doctor suspects a possible Demodex mite infestation as well, he may recommend a tea tree oil-based antidandruff shampoo. This product not only tackles the flakiness but also works as a disinfectant to kill the blepharitis-causing parasite. (6)
3. Consume Omega-3 Fatty Acids
Omega-3 fatty acids are credited with substantial anti-inflammatory properties that can help reduce the symptomatic discomfort caused by blepharitis.
The therapeutic effect of these fatty acids is more marked in cases where the blepharitis is linked with other skin conditions such as ocular rosacea.
According to a 2013 randomized controlled trial published in the International Journal of Ophthalmology, the dietary supplementation of omega-3 fatty acids helped provide symptomatic relief from dry eye syndrome, blepharitis, and meibomian gland disease. (7)
However, the exact role of omega fatty acids in improving or stabilizing tear production and secretion needs to be researched further for a clearer understanding. (7)
Some rich dietary sources of omega-3 include fish, flaxseeds, and walnuts. If you fail to derive your recommended intake through dietary intake alone, you can consult your doctor about starting a supplement.
For any dietary intervention to bear successful results, it is essential to make it part of an overall healthy and well-balanced diet. As far as supplementation is concerned, always stick to the doctor-prescribed dosage to avoid any complications.
The simple eyelid hygiene measures and self-care tips listed above can help reduce the discomfort associated with blepharitis but do not provide a permanent redressal of the problem. These preliminary treatments need to be approved by your doctor first, who may recommend additional medical interventions to treat your condition.
Types of Blepharitis
Blepharitis can be categorized into two types depending upon the site of occurrence:
Anterior Blepharitis: The skin at the base of the eyelashes along the outside front edge of the eyelid becomes inflamed.
This condition is usually caused by a buildup of bacteria or dandruff in the folds of the eyelids in the absence of proper eyelid cleanliness.
Posterior Blepharitis: The inflammation is limited to the inner corners of the eyes, where the eyelid meets the eyeball.
The condition usually occurs when the meibomian glands do not function properly and do not produce insufficient oil to keep the eyes well hydrated.
This kind of eyelid inflammation is unlikely to cause any serious or permanent damage to your eyesight. However, it is recognized as one of the top causes of dry eyes.
Posterior blepharitis can be a source of considerable discomfort. It can make your eyes red, flaky, irritated, and itchy. Lack of proper eyelid hygiene exacerbates the symptoms.
Is Blepharitis Contagious?
Blepharitis is not contagious. However, it is a long-term condition marked by repeated flare-ups that are followed by periods of remission.
There is no permanent cure for this condition yet, but a typical case of blepharitis can be effectively managed by keeping your eyelids clean regularly.
If the inflammation is triggered by an overgrowth of bacteria, your eye specialist may prescribe an antibiotic course along with an eyelid hygiene routine.
Can one get blepharitis from having eyelash extensions?
Cosmetic eyelash extensions can introduce extra dirt, bacteria, and demodex mites to the eyelids and may be less efficient in shielding the ocular surface of the eyes.
Moreover, these eyelashes are often attached to the lid with an adhesive that can trap contaminants. The process of inserting the hair can damage and irritate the sensitive skin of the eyelid, subsequently giving rise to inflammation.
Thus, there is more than one reason to believe that getting lash extensions can put you at an increased risk of blepharitis. (8)
Do blepharitis symptoms become worse in the morning?
Blepharitis symptoms tend to be at their worst when you wake up in the morning. This is because your blepharitis-affected eyelids remain in contact with the ocular surface throughout the night while you sleep, resulting in greater discomfort on awakening.
Thus, keeping your eyes shut for such a prolonged time on end aggravates the discomfort in your eyes.
Can blepharitis cause trichiasis?
Long-term blepharitis can cause misaligned growth of eyelashes, sometimes in an inward direction toward the globe of the eye. This abnormal inverted growth of eyelashes is referred to as trichiasis.
When the lashes are positioned toward the eye rather than away from it, they rub against the eyeball. The friction can cause discomfort and even scarring.
People with any of the following skin conditions have an increased susceptibility to developing blepharitis:
- Seborrheic dermatitis, which is a medical name for dandruff of the scalp and eyebrows
- Rosacea, which makes your skin red and blotchy
- Acne in adolescents and young adults, which can irritate or block the meibomian glands at the center of the face
Complications of Blepharitis
Blepharitis is unlikely to give rise to any serious complication if it is managed properly. However, the eye inflammation can make it impossible for you to wear contact lenses until the symptoms subside.
Besides the general discomfort, blepharitis can lead to the following eye-related problems:
- Dry eye syndrome: Blepharitis is often caused by a meibomian gland dysfunction, which means that your eyes do not produce enough oil to keep the tear film intact.
Thus, your tears evaporate more rapidly, leaving your eyes dry, red, and inflamed – a condition known as dry eye syndrome.
- Conjunctivitis (pink eye): Blepharitis is associated with another similar inflammatory eye condition called conjunctivitis.
The white part of the eye, or the sclera, is engulfed by a thin, transparent mucous membrane called the conjunctiva, which extends to the inner surfaces of the eyelids.
The conjunctiva is supplied with multiple fine blood vessels. When the conjunctive is irritated or inflamed, the blood vessels expand and become more visible. This makes your eye appear unusually red or bloody, which is why the condition is often referred to as pink eye.
People with blepharitis are more prone to inflammation of the conjunctiva, especially if their symptoms are particularly severe or chronic.
- Meibomian cyst: Blepharitis is the inflammation of the meibomian glands, which are located along the rim of the eyelids, under the skin.
Swelling in any of these glands can take the form of a cyst. Such cysts are referred to as meibomian cysts, as the inflammation originates from the meibomian glands. These cysts are usually painless unless they get infected.
- Styes: Bacterial blepharitis can lead to the development of a painful pus-filled boil or swelling on the external edge of the eyelid. This small lump is called a stye and is caused by a buildup of infectious bacteria near the base of your eyelashes.
How to Prevent Blepharitis?
Several everyday measures can be taken to prevent blepharitis. Here are some of them:
- If you are just beginning your blepharitis treatment, you are usually advised to avoid makeup. This is because the product you put on your face can get into your eyes and further exacerbate the irritation.
Once the symptoms become less intense, you may consider using makeup again, but still refrain from putting too many products on your eyes.
- You must replace all the eye products that you have previously used in or near the affected eyelids as they may have picked up the contaminated debris, bacteria, or mites.
- Never go to sleep with your makeup on. Make sure to remove every trace of makeup from your face, especially from your eyes, to allow the skin to breathe while you sleep.
- Because blepharitis usually hampers natural tear secretion by blocking the meibomian glands, you can use over-the-counter artificial tears to lubricate your eyes.
- It is best not to apply an eyeliner too close to the lash line.
- Gently clean any excess tears or eye drops that may have settled on your eyelashes, from time to time.
- Wearing contact lenses regularly means inserting a foreign object into their eyes for prolonged periods.
Therefore, exercise extra-precaution with regard to eye cleanliness. Handling your lenses with unclean hands can introduce germs, dust, and other impurities in your eyes and trigger a blepharitis flare-up.
Thus, practice proper hand sanitization before and after applying your lenses. It is just as important to store your lenses properly and clean your lens case every now and again.
When to See a Doctor
Blepharitis is a chronic condition that can occur frequently and then subside only to resurface again.
There is currently no permanent cure for blepharitis, but you can effectively manage its symptoms by practicing proper eye hygiene daily. Certain self-care tips and therapies can also help relieve the eye inflammation.
However, if these preliminary measures fail to improve your condition or if you experience particularly severe and unrelenting symptoms, consult an optician (optometrist) for a more comprehensive medical assistance. Do the same if your symptoms worsen at any point in time.
The doctor will examine your eyes to determine if there is an underlying condition that is causing the inflammation and may refer you to a specialist if necessary.
Prompt treatment is key to avoiding complications associated with blepharitis. However, bear in mind that even the most successful treatment strategy does not guarantee that the condition will resolve for good.
What you may ask your doctor:
- What are the possible causes of the flare-up of my blepharitis symptoms?
- Is my condition linked to a medical disorder?
- Is this condition usually temporary or long-lasting?
- How long will my blepharitis flare-up last?
- Do I need to get any tests done?
- Does sunlight exposure aggravate the problem?
What your doctor may ask you:
- Did you come in contact with a person who had a recent eye infection?
- What are your symptoms and when did you first notice them?
- Do your symptoms come and go, or are they persistently present?
- Are the symptoms more evident at any particular time of the day?
- Have you changed cosmetic brands recently?
- Do you use contact lenses?
Blepharitis is a prolonged struggle as it keeps coming back even after the symptoms resolve. The most you can expect is to successfully manage the symptomatic discomfort and reduce the frequency of flare-ups.
However, you can rest easy knowing that this condition is unlikely to cause any serious damage to your eyes or vision, except for making them look rather unsightly when the inflammation is at its peak.
Regularly cleaning your eyelids is the cardinal rule in avoiding an aggravation of blepharitis. Couple this with expert-recommended dietary interventions and self-care practices.
If you do experience worsening of your condition or if you fail to register relief despite the initial treatment, visit your eye doctor without delay.
Expert Answers (Q&A)
Answered by Dr. Annie Negrin, MD (Ophthalmologist)
Blepharitis (from Greek, meaning “inflamed eyelids”) is actually caused by a clogging of the oil glands that run the length of our eyelids.
We have dozens of these glands on the upper and lower lids, and they open up just at the base of the eyelashes. This oily material is necessary for a healthy tear film.
With chronic clogging over the glands over time, you develop the chronic problem of blepharitis, tearing, burning, red itchy eyes, and a feeling of sand-like substance in the eyes.
With blepharitis can come the problem of one of these many baseline-clogged glands getting very clogged until you feel a bump, or “stye” along the lid.
Once we realize that blepharitis is a disorder of lipid (oil) producing glands, we can understand what factors can be affecting them. In this case, when we are stressed, our stress hormone levels (like cortisol) can skyrocket.
Oil glands can be heavily influenced by hormonal regulation, as any teenager will tell you. So stress most certainly can affect the way these glands produce, secrete, and clear any oily material.
Unfortunately, parts of the eyelid architecture that are lost from the chronic scarring of blepharitis usually do not grow back in a normal fashion. These lid irregularities can lead to worsening of dry eye symptoms, so it is important to treat it.
Manuka honey is known for its strong antimicrobial properties, mainly because of its very high concentration of methylglyoxal (MG) compared to other types of honey. It is a great natural antibiotic to put on wounds and ulcers.
I do not tend to recommend using this in or around the eyes and delicate lid tissue.
Regular lid hygiene, as described, is great prevention of bacterial overgrowth. I would stick to using the honey for minor scrapes and burns!
Blepharitis can be cured with proper treatment and patience on the part of both physician and patient. This is a form of ocular surface disease that can be especially tough to treat in patients with other dermatologic and/or inflammatory conditions such as rosacea.
Often, treatment involves patient compliance with compresses and hygiene, along with proper eye drops or ointments to prevent infection and decrease the inflammation.
Dr. Anne Negrin, MD: Dr. Negrin is a Board Certified Comprehensive Ophthalmologist, she sees patients from newborns to senior years. She attended Cornell University and received her MD from New York Medical College.
She completed a year of internal medicine training at North Shore-LIJ Hospital in Manhasset, Long Island, and then completed her Ophthalmology residency training at St. Vincent’s Catholic Medical Centers of Brooklyn and Queens.
Dr. Negrin writes regularly on a variety of health and wellness topics, and can also be seen on various TV and cable news shows as a contributing medical commentator. She runs a private practice in Westchester, NY and is a passionate educator.